Healing Architecture in Birthing Rooms: A Scoping Review

Abstract

Aim:

The purpose of this scoping review is to map the knowledge about the multisensory birthing room regarding the birth experience and birth outcomes.

Background:

The concept of multisensory birthing rooms is relatively novel, making it relevant to explore its impact.

Methods:

Five databases were searched. The search was limited to articles in English, Danish, Norwegian, and Swedish. There were no time limitations. Fourteen relevant articles were identified providing knowledge about multisensory birthing rooms.

Results:

Eight articles focused on birth experience, six articles focused on birth outcome, and one on the organization of the maternity care. Seven of the studies identified that sensory birthing rooms have a positive impact on the birth experience and one qualitative study could not demonstrate a better overall birth experience. Five articles described an improvement for selected birth outcomes. On the other hand, a randomized controlled trial study could not demonstrate an effect on either the use of oxytocin or birth outcomes such as pain and cesarean section. The definition and description of the concept weaken the existing studies scientifically.

Conclusions:

This scoping review revealed that multisensory birthing rooms have many definitions and variations in the content of the sensory exposure; therefore, it is difficult to standardize and evaluate the effect of its use. There is limited knowledge concerning the multisensory birthing room and its impact on the birth experience and the birth outcome. Multisensory birthing rooms may have a positive impact on the birth experience. Whereas there are conflicting results regarding birth outcomes.

Keywords

healing architecture delivery room hospital design physical environment birth satisfaction birthing rooms multisensory birthing room

Introduction

In recent years, major attention has been paid to the importance of the physical space and its importance for the well-being of patients. The term “healing architecture” was introduced in the 1980s (Simonsen et al., 2022; Ulrich, 1984). There is no clear definition of healing architecture; nevertheless, the term is widely used in the literature and conceptually covers architecture, interior design, and physical settings that affect the healing ability (Aripin, 2006; Simonsen et al., 2022; Thaddeus & Napoleon, 2021). Other terms are used for similar rooms, for example, the “Snoezelen room,” a Dutch term for a controlled multisensory environment that means a room designed to stimulate the senses of people. Multisensory birthing rooms aim to promote comfort and relaxation, thereby causing endorphin release and thus enabling a person’s pain-coping capacities (Schofield et al., 1998). Throughout this article, we will use the term multisensory birthing room to describe birthing rooms using individual or combined visual or auditory effects.

Multisensory birthing rooms are intended to create an immersive environment that can support women giving birth and visitors by reducing stress and increasing well-being in the process (Thaddeus & Napoleon, 2021; Ulrich et al., 2008). Studies have shown that images of nature reduce stress, fear, and pain perception (Spiegel et al., 2019; Ulrich, 1991). Daylight and scenic vistas of nature are some of the elements that previously have shown positive effects on the healing process (Aripin, 2006; Grahn et al., 2021; Thaddeus & Napoleon, 2021). Ulrich et al. describe how to use the “positive distraction” strategically to remove the patient’s attention from pain or anxiety and thus reduce the experience of the pain (Ulrich, 1991).

Giving birth is a life-changing event that generates major psychological impact and physiological changes in the mother (Aune et al., 2015; Nielsen & Overgaard, 2020; Olza et al., 2018). Natural birth is defined as vaginal delivery without complications and with only limited use of medication (Prosser et al., 2018). An essential factor during birth is that the birth-giving mother feels safe and relaxed. The hormone oxytocin promotes natural birth and works optimally when the mother feels safe and relaxed, while the hormone adrenaline inhibits or completely stops the progress of the birth (Uvnäs-Moberg et al., 2019). The surrounding environment significantly affects the amount of oxytocin measured in the blood during childbirth and is very important for feelings of well-being, calmness, and empowerment (Uvnäs-Moberg et al., 2019). Additionally, maternity wards that are designed to be functional and still reduce the feeling of being in a hospital affect the well-being of midwives and, thereby, improve patient care (Hammond et al., 2017).

A scoping review from the World Health Organization that explored the evidence of the importance of art for health describes how music during childbirth is associated with a better birth experience and, indirectly, fewer birth complications (Fancourt & Finn, 2019). A systematic review focusing on how the design of a birthing room influences the maternal and neonate physics, and emotions document the importance of a design with distraction, comfort, welcoming design, an appropriate temperature, familiarity, and a diminished technocratic environment (Nilsson et al., 2020). Another review investigated whether the architecture and design of a birthing room impact intrapartum interventions and concluded that not only the design of the birthing room but also behavior, experience, and practice of the health providers influence the intrapartum interventions (Setola et al., 2019). Multisensory birthing rooms are different in these regard in that birthing room does not need to look like conventional hospital rooms (Hodnett et al., 2012) and cover interior, light, sound, pictures, film, and art. The existing evidence in this area is not clear. A randomized controlled trial (RCT) comparing childbirths in a standard birthing room to childbirths in a specially designed birthing room did not find any difference in clinical obstetric outcomes (Lorentzen et al., 2021). In contrast, an observational retrospective cohort study found that births in sensory birthing rooms, which are characterized by the installation of different visual and auditory effects, can be associated with a lower risk of cesarean section (Wrønding et al., 2019).

The increased attention toward multisensory birthing room and its potential role makes it relevant to uncover its effects in a maternity ward. The purpose of this scoping review is to map the knowledge about multisensory birthing room regarding the birth experience and birth complications.

Materials and Methods

A scoping review provides an overview of existing literature and is distinguished from a traditional systematic review by its research question being slightly broader and can thus examine the scope of literature within a given topic (Levac et al., 2010). Additionally, scoping reviews are characterized by typically not assessing the evidence of included studies (Levac et al., 2010). The motivation for this scoping review is based on the fact that the existing reviews focus more formally on design and architecture in birthing rooms. However, clinicians need a review that intertwines knowledge about multisensory birthing rooms with complication rates and birth experience. This scoping review is based on the methodological framework by Levac et al. (2010). The framework consists of six stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting results; and (6) consultation. At Stage 1, the research question was identified as follows: To explore existing literature on how healing architecture in a hospital birthing room affects birth experience and birth outcomes. At Stage 2, we performed a literature search linked to the research question.

This search was conducted with the help of an experienced librarian (C.S.) in collaboration with clinicians in the field of obstetrics. At Stage 3, two independent persons (A.E. and D.M.) reviewed the articles, initially at the title and abstract level and then at the full-text level. If necessary, a third person, an obstetrician (L.B.), resolved disagreements. Further, at Stage 4 in Levac’s framework, the authors collaborated to complete an analysis of emerging data. We then, at Stage 5, provided an overview of the literature and data using an analytical framework. Finally, Stage 6 covered the involvement of stakeholders.

Literature Search

Search strategy

The following databases were searched: Ovid MEDLINE^® (1946-August 2023), OVID Embase (1974-August 2023), Ebsco CINAHL with full text (1937-August 2023), Clarivate Web of Science Core Collection (1900-August 2023), and Wiley Cochrane Library (1993-September 2022). All databases were searched in August 2021 and updated in August 2023.

The search strategy was developed by a librarian (C.S.) along with the first author (A.E.) and last author (D.M.) and peer-reviewed by another librarian.

We searched for Birth settings and Architecture using both controlled vocabulary terms, that is, Mesh terms and natural language terms for their synonyms. The search was limited to articles in English, Danish, Norwegian, and Swedish. There were no time limitations. A total of 1,861 unique citations were retrieved from the five databases. Duplicates (1,014) were removed by the librarian (C.S.) using Endnote and Covidence’s duplicate identification strategies. See the strategy for Ovid MEDLINE^® in Table 1.

Table 1.

Search Strategy for Ovid MEDLINE^®.

#	Query
1	Delivery Rooms/or Delivery, Obstetric/or Birthing Centers/or birth setting/	35,288
2	Environment, Controlled/	4,344
3	Environment Design/	7,234
4	exp Architecture/	27,492
5	exp Health Facility Environment/	7,279
6	2 or 3 or 4 or 5	43,635
7	1 and 6	145
8	“birth environment*”.ti, ab, kw.	179
9	((delivery or labor or labour or birth* or childbirth) adj3 ((Room or unit* or center* or centre* or facility or facilities or setting) adj3 (design or environment* or interior* or architecht* or architect* or snoezelen))).ti, ab, kw.	193
10	7 or 8 or 9	460
11	limit 10 to (danish or english or norwegian or swedish)	448

Study selection

To be included in this review, articles needed to focus on the effect of birthing room on aspects of birth experience and birth outcomes. Articles were included if they were written in English, Danish, Norwegian or Swedish. Literature reviews, protocols, conference abstracts, editorial comments, and articles not available in the full text were also excluded. We excluded studies with wrong outcomes and interventions e.g. studies that examine the effect of multisensory birthing rooms and the staff experience.

Figure 1.

PRISMA flow diagram with search results, study selection, and reasons for exclusion of studies.

Results

This scoping review identified 14 articles eligible for this study (Table 2). Thirteen of the articles were published within the last ten years. Eight of the articles were Scandinavian studies (four from Denmark and four from Sweden), two were from Iran, one from Saudi Arabia, Germany, Canada and Australia respectively. Nine studies were quantitatively designed (eight RCT and one cohort study), three were qualitative, and two were mixed-method studies.

Table 2.

Summary of Included Articles.

Lead Author, Year, Country	Study Aim(s)	Study Design, Inclusion and Exclusion Criteria, Intervention, Data Collection, and Analysis Methods	Study Participants (N)	Primary Outcomes	Results
Aburas et al., 2017, Saudi Arabia (Aburas et al., 2017)	Examining impacts of visual nature stimuli on women during labor	RCT^a Inclusion criteria: ≥18 years of age, proficient in English, planned vaginal birth, one previous cesarean section and planned to do a vaginal birth Exclusion criteria: Multiple cesarean sections, previous preterm labor, currently known fetal anomalies, or a high-risk pregnancy. Intervention: Nature images on the TV screen. Control group had access only to the regular TV.	50	(1) Scores on a subscale of the QPP^b questionnaire, (2) labor duration, (3) blood pressure, (4) pain relief, and (5) Apgar score	Nature imagery in the labor and birthing room had positive impacts on women during labor, including lower heart rates, higher QPP scores in three individual items in the evaluation of their labor experiences, and higher mean Apgar scores (5-min assessment) in the newborns.
Ayerle et al., 2023, Germany (Ayerle et al., 2023)	To investigate the effect of a designed birthing room on the rate of vaginal births	RCT. Inclusion criteria: Primiparous and multiparous women with a singleton fetus in cephalic presentation, intended vaginal birth, gestational age at the onset of labor be between 37 + 0 and 41 + 6 and in active first stage Exclusion criteria: Water birth, pathological CTG on admission, indication for CS or emergency admission. Intervention: Giving birth in an intervention birthing room where the birthing bed where arranged different compared to giving birth in a standard birthing room	3,719	The probability of vaginal births	Increased vaginal birth rates in both comparison groups can be explained by the high motivation of the women and the staff The difference was not significant
Goldkuhl et al., 2021, Sweden (Goldkuhl et al., 2021)	Explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of the two differently designed birthing rooms	An ethnographical study Observations and subsequent interview Inclusion criteria: Nulliparous women classified as Robson 1, ≥18 years of age, understand and speak Swedish or English, or have an interpreter in Somali or Arabic Exclusion criteria: No information Intervention: Giving birth in a standard birthing room versus a furnished birthing room, designed to be adapted to birthing women’s wishes and needs	16	(1) Practices, (2) interactions, (3) experiences, (4) perceptions, and (5) conceptions	Institutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room
Goldkuhl et al., 2022, Sweden (Goldkuhl et al., 2022)	To evaluate whether a birthing room designed with person-centered considerations improves labor and birth outcomes for nulliparous women compared to regular birthing rooms	RCT Inclusion criteria: Women ≥ 18 years classified as Robson 1 in active stage of labor. Participants also needed to understand Swedish, English, Arabic, or Somali or have access to an interpreter Exclusion criteria: Planned cesarean birth and latent phase of labor Intervention: A refurbished room designed with person-centered considerations versus a regular birthing room	406	A composite of four variables: (1) vaginal noninstrumental birth, (2) no oxytocin augmentation of labor, (3) postpartum blood loss < 1,000 ml, and (4) a positive childbirth experience (rated 7–10 on a Visual Analog Scale [VAS] 1–10)	No significant difference in fulfilling all the four variables in the composite primary outcome. In the secondary outcomes, like epidural, required the participants in the designed birthing room significantly fewer epidural analgesia than in the regular rooms. Women giving birth in the designed birthing room reported a significantly higher sense of safety, control, integrity, adaptability, and meaningfulness
Goldkuhl et al., 2023, Sweden (Goldkuhl et al., 2023)	To investigate the impact of the birthing room design on the childbirth experience of nulliparous women	RCT Inclusion criteria: Women ≥ 18 years classified as Robson 1 in active stage of labor. Participants also needed to understand Swedish, English, Arabic, or Somali or have access to an interpreter Exclusion criteria: Planned cesarean birth and latent phase of labor Intervention: A refurbished room designed with person-centered considerations versus a regular birthing room	406	Change in the birth experience over time	To give birth in a new birthing room has a positive effect on the birth experience measured after 3 months and 12 months
Hansen et al., 2022, Denmark (Hansen et al., 2022)	To evaluate women and partners’ experience of birth in a “birth environment room” compared to a standard birthing room	RCT. It is a secondary analysis of a randomized controlled trial (Lorentzen et al., 2021) Inclusion criteria: Nulliparous women and their partners, >18 years who speak Danish in spontaneous labor at term with a fetus in cephalic presentation Exclusion criteria: Gestational age week <36, not in active labor and went home or had the labor induced, was already induced, unexpected breech Intervention: Giving birth in a “sensory environment birthing room” compared to giving birth in a standard birthing room	680	The overall birth experience and satisfaction with care of the women and their partners. These secondary outcomes were measured on a Likert-type scale, obtained in the postpartum questionnaire	The birth environment room did not improve the overall experience of birth for women and partners. Partners in the intervention group were overall more satisfied with care
Hauck et al., 2008, Australia (Hauck et al., 2008)	Explore women’s experience of using a Snoezelen room during their labor	A qualitative exploratory design. Inclusion criteria: 35 completed gestational weeks Exclusion criteria: Insulin-dependent diabetics, weight >125 kg, women with severe pre-eclampsia, no neonatal nursery, no access to 24 hr on-site medical consultants Intervention: Giving birth in a Snoezelen room versus a standard birthing room	16	(1) relaxation, (2) comfort, (3) environmental control, (4) choice of complementary therapies, and (5) safety in a nonclinical atmosphere	All participants indicated that they would use the room in a future labor and recommend it for other laboring women
Jamshidi Manesh et al., 2015, Iran (Jamshidi Manesh et al., 2015)	Evaluate the effects of Snoezelen room on childbearing outcome	RCT. Inclusion criteria: 4-cm dilated cervix; intact membrane; no indication for cesarean section; no history of asthma and allergy, no pulmonary or heart diseases, high blood pressure, diabetes, or infertility; and no cervical cerclage in the current pregnancy Exclusion criteria: Emergency cesarean section Intervention: Giving birth in a Snoezelen room	100	(1) Pain intensity, (2) duration of labor, and (3) perinea status in nulliparous women	The mother’s pain intensity, the length of labor (first labor phase), and incidence of episiotomy decreased significant
Lorentzen et al., 2021, Denmark (Lorentzen et al., 2021)	The effect of giving birth in a specially designed “sensory environment birthing room”	RCT. Inclusion criteria: Nulliparous women > 18 years who speak Danish in spontaneous labor at term with a fetus in cephalic presentation Exclusion criteria: Gestational age week < 36, not in active labor and went home or had the labor induced, was already induced, unexpected breech Intervention: Women were randomized to a “sensory environment birthing room” or a standard birthing room	680	Augmentation of labor by use of oxytocin	Birthing in a specially designed birth environment did not lower the use of oxytocin for augmentation of labor Neither did it have any effect on duration of labor, use of pharmacological pain relief, and chance of birthing without complications
Momeni et al., 2020, Iran (Momeni et al., 2020)	The efficacy of the Snoezelen room on fear, anxiety, and satisfaction of childbirth	RCT. Questionnaire CAQ and VAS. Inclusion criteria: Absence of known medical conditions, such as migraine, epilepsy, asthma, allergies, age 18–35 years, gestational age of 37–42 weeks, estimated embryo weights of 2,500–3,500 g, head and pelvic fitness, cephalic examination, no stressed events in the previous 6 months, dilatation of 3–4 cm at the beginning of the study, low-risk pregnancy, and normal pattern of fetal heart rate Exclusion criteria: An emergency cesarean for medical reasons Intervention: Birthing in the Snoezelen room versus a standard room	130	(1) Fear, (2) anxiety, and (3) satisfaction with childbirth	A significant reduction in fear in the active phase and postpartum in the intervention group compared with the control group. Anxiety showed a significant difference and was lower at dilatation of 6–7 and 7–8 cm and after childbirth in the interventional group. The satisfaction with childbirth significantly increased in the interventional group
Murry-Davis et al., 2023, Canada (Murray-Davis et al., 2023)	Explore how the physical environment affects people’s experiences and the meanings that people attribute to the physical environment	A mixed-methods study. Inclusions criteria: All the midwifery service users admitted to the midwifery unit and all the midwifes in the midwifery units Intervention: The midwifery unit was designed “home-like,” more aesthetic and less institutional and more personal	59 Questionnaires 39 Interviews 3 Participants in one focus group	The birth experiences and overall satisfaction with the built environment for both midwifery service users and midwifes	The findings demonstrate high levels of satisfaction with the birth environment
Nielsen et al., 2020, Denmark (Nielsen & Overgaard, 2020)	Explore women’s experience of the environment and its ability to support the concept of patient centeredness in the care of birthing women	A qualitative study with interviews undertaken 3–7 weeks after birth. This study is an adjunct study to the RCT by Lorentzen et al. (2021) Inclusion criteria: Danish speaking, age >18 years, nulliparous with a spontaneous onset of labor and a baby in a head-down position and gestational age 37–42 + 0 Exclusion: Not reported Intervention: Birth in an alternative birthing room	14	(1) Emotional support, (2) involvement of family, and (3) physical comfort	Overall, women’s experiences of giving birth in the alternative birthing room were positive. The environment offered a stress- and anxiety-reducing transition to the hospital setting, at the same time as it helped them obtain physical comfort. The environment also signaled respect for the family’s needs as it supported physical and emotional interaction between the woman and her partner and helped relieve her concern for the partner’s well-being
Skogström et al., 2022, Sweden (Skogström et al., 2022)	To explore women’s experiences of physical features in a birthing room	A mixed-methods study Inclusion: Women ≥ 18 years classified as Robson 1 in active stage of labor. Invited women had to speak either Swedish or English Exclusion: Women with induced labor, planned cesarean section, and multiple gestations, or in latent phase of labor were excluded Intervention: Women were randomized to give birth in a regular or refurbished birthing room (new room). A new room had more physical features, this is to increase the ambiance of the room to individual wishes or need	202 Questionnaires 19 Interviews	(1) Meaningfulness of the physical features in the birthing room, (2) ranking of physical features in the birthing room, and (3) women’s experiences of the birthing room, described in categories	93.6% (n = 189) assessed the physical features in the birthing room as meaningful to a very high or high extent. The overall impression of the room was positive and exceeded women’s expectations. The ranking of the nine physical features proved the bathtub as the most important
Wrønding et al., 2019, Denmark (Wrønding et al., 2019)	Analyze the risk of obstetrical interventions among women giving birth for the first time in a sensory birthing room versus a standard birthing room	A retrospective cohort study. Inclusion criteria: Robson group 1 Exclusion criteria: Phase 3 labor Intervention: Giving birth in sensory birthing rooms with spectral light. Women had to give birth for the first time in a standard birthing room or in a sensory birthing room. A sensory birthing room had spectral light setting compared to a standard birthing room	789	(1) Use of additional oxytocin during labor and (2) risk of cesarean delivery	Additional oxytocin infusion was reduced, and the risk of cesarean delivery was significantly decreased when giving birth in a sensory room compared with a standard birthing room

^a Randomized controlled clinical trial. ^bQuality of Care from the Patient’s Perspective.

Notes: CTG: cardiotocography, CS: cesarean section, CAQ: Childbirth Attitude Questionnaire.

Eight studies focus on the birth experience, and six describe the birthing room’s impact on obstetric outcomes. One study focused on the organization of maternity care. The article from Aburas et al. examines both obstetric outcomes and birth experience, and therefore this article is categorized under both. The total number thus becomes 15 when summing up the articles under each of the three categories.

Birth Experience

An RCT found that introducing nature imagery to the labor and birthing room resulted in higher Quality of Care From the Patient’s Perspective (QPP) scores in the mothers’ evaluation of their labor experiences (Aburas et al., 2017). A qualitative exploratory study found that women recommended a multisensory birthing room to other laboring women (Hauck et al., 2008). An RCT (Momeni et al., 2020) and a qualitative study (Nielsen & Overgaard, 2020) showed that a multisensory birthing room could reduce anxiety and improve childbirth satisfaction. A mixed-methods study concluded that there is a high level of satisfaction with the birth environment for both midwifery service users and midwives when the birthing rooms are made “home-like” (Murray-Davis et al., 2023). Another RCT demonstrated that the positive birth experience after birth in a multisensory birthing room persists over time. In this study, the birth experience was evaluated after 3 and 12 months (Goldkuhl et al., 2023). A mixed-methods study explored women’s experiences of physical features in a birthing room and found that 93.6% of the women assessed the physical features in the birthing room as meaningful to a high extent. The study found that the overall impression of the room was positive (Skogström et al., 2022). One qualitative study comparing childbirths in standard birthing rooms (control) with new birthing rooms (intervention group) could not demonstrate a better overall birth experience in the intervention group but found that the partners in the intervention group were more satisfied with care. In this study, the new birthing room was furnished with materials and furniture that created a homely atmosphere and video projections on the walls featuring nature scenes to bring nature into the room (Hansen et al., 2022).

Birth Outcomes

An RCT showed that giving birth in a multisensory birthing room decreased the length of labor and incidence of episiotomies compared to giving birth in a standard birthing room (Jamshidi Manesh et al., 2015). A retrospective cohort study (n = 789) found that the risk of cesarean delivery was significantly decreased (OR = 0.57; 95% CI [0.33, 0.97]), and the use of oxytocin infusion was reduced with giving birth in a sensory room versus a standard birthing room (OR, multiple adjusted: 0.71; 95% CI [0.50, 1.03]); (Wrønding et al., 2019). Aburas et al. reported a higher Apgar score in children birthed in a room with visual nature stimuli, and Goldkuhl et al. found significantly lower use of epidural analgesia in births in newly refurnished birthing rooms, where there was a more home-like atmosphere with a sofa, bedspread, cabinet for personal belongings, and the option of dimmed lighting, compared to the regular birthing rooms (Aburas et al., 2017; Goldkuhl et al., 2022). An RCT compared the rate of vaginal birth between a birthing room designed to encourage mobility, self-determination, and uptake of upright maternal positions in labor to a standard birthing room and found no significant difference between the groups (Ayerle et al., 2023).

In one RCT, giving birth in a multisensory birthing room had no effect on either the use of oxytocin or birth outcomes compared to births in a standard birthing room (Lorentzen et al., 2021).

Organization of the Maternity Care

An ethnographical study in Sweden with observations and a subsequent interview found that the organization of maternity care has a more significant impact on the birth experience than the birthing room. A birthing room can be designed to create calmness, safety, and familiarity, but if the personal needs of its users are disregarded in favor of the local instructions and professional recommendations, the importance of the spatial framework will become less significant. The study from Sweden showed that the local instructions and guidelines had a greater influence on the birthing women regardless of whether they gave birth in a regular birthing room or a refurbished birthing room (Goldkuhl et al., 2021).

Discussion

This scoping review aimed to uncover existing knowledge about multisensory birthing rooms and how the environment affects the birth experience and birth complications. The literature search suggested that there were few studies to cover each of these aspects.

Birth Experience

In recent years, there has been an augmented focus on the impact of multisensory birthing rooms on the birth experience. Seven of the eight studies document a positive effect of nature images or multisensory birthing rooms to give better physical comfort and reduce anxiety (Aburas et al., 2017; Goldkuhl et al., 2023; Hauck et al., 2008; Momeni et al., 2020; Murray-Davis et al., 2023; Nielsen & Overgaard, 2020; Skogström et al., 2022). One study could not demonstrate that the birthing room affected the overall experience (Hansen et al., 2022). The overall positive impact of multisensory birthing rooms on birth is supported by studies that investigate the effect of multisensory birthing rooms in other health contexts, for example, in dental clinics or for psychiatric patients (Haig & Hallett, 2022; Ismail et al., 2021).

Obstetric Outcomes

There was an overall trend toward birthing rooms that were furnished based on principles of multisensory rooms with sensory stimuli that were able to reduce the number of complications. Four of the six studies documented an individual positive effect on the pain intensity, length of labor, episiotomy, risk of cesarean delivery, the use of oxytocin infusion, and the Apgar score in newborns compared with a standard-birthing room (Aburas et al., 2017; Goldkuhl et al., 2022; Jamshidi Manesh et al., 2015; Wrønding et al., 2019). From the literature, it is well known that nature images can reduce the level of stress hormones (Ulrich, 1991), and other studies find a positive effect of nature images on pain levels (Diette et al., 2003; Tse et al., 2002). There are divergent results recording births outcomes as a Danish study showed no effect in reducing complications such as cesarean delivery, oxytocin for augmentation and blood loss (Lorentzen et al., 2021), while another Danish study showed that giving birth in a multisensory birthing room could be associated with a lower risk of cesarean delivery (Wrønding et al., 2019). The largest RCT in this field with more than 3,700 participants demonstrated similar vaginal birth rates in specially designed and standard birthing rooms in both comparison groups (Ayerle et al., 2023). Different inclusion and exclusion criteria cannot explain the diverging results, as most of the studies have similar criteria (Goldkuhl et al., 2022; Lorentzen et al., 2021; Wrønding et al., 2019) and include women from Robson Group 1. The Robson’s Ten-Group Classification System divides the women into 10 groups based on obstetric characteristics, which makes it easier for healthcare professionals to compare obstetric outcomes. Robson Group 1 is defined by nulliparous, single, cephalic position, ≥37 weeks, and spontaneous labor (Zeitlin et al., 2021). One study has not divided the women into Robson classification and excludes women in active labor without any systematic medical diseases (Jamshidi Manesh et al., 2015).

Organization of the Maternity Care

An ethnographical study concludes that the institution’s culture permeates the birthing room, independent of the room’s design (Goldkuhl et al., 2021). The reason for this could be credited to the variety of healthcare providers involved in childbirth, their specific role, how they adapt and interact within the room design and facilities, how they integrate themselves into the birth experience, or the timing of entry into the birthing room. Furthermore, the culture of the institution may have an impact on the midwife´s way of providing care. In the study by Goldkuhl et al., the culture was more important than the design of the room (Goldkuhl et al., 2021).

Strengths and Limitations

This scoping review gives the ability to identify the use of healing architecture in birthing rooms. The review is strengthened by rigorous methods based on prespecified criteria defined by Levac et al. (2010). Due to the heterogeneity in methodology, terminology, and assessment procedures used in the included articles, the generalization of study results is limited.

This scoping review is based on searches in the most common health and architecture research literature databases and with no time limit, which can strengthen its validity. Our review was limited by only screening articles available in English or Scandinavian languages. Secondly, we did not appraise the publications’ quality including validity as this is not part of the scoping review method. Another limitation is the heterogeneity of the studies in terms of defining multisensory birthing rooms. Some of the rooms in the included studies had an aquarium, a projector making optical shapes, light music, or aromatherapy (Aburas et al., 2017; Hauck et al., 2008; Momeni et al., 2020). In the studies from Nielsen et al. and Hansen et al., the birthing room was refurnished, with visual, auditory stimuli on three walls and a focus on the interior (Hansen et al., 2022; Nielsen & Overgaard, 2020). The fact that the rooms are arranged very differently means that comparing the effect of these very heterogenic exposures is extremely difficult.

Conclusion

The included studies in this review focused on three main categories: birth experience, obstetric outcomes, and organization of maternity care. Based on the identified evidence, this scoping review demonstrates that a multisensory-adapted birthing environment may improve the birth experience and that there is also a trend toward a reduction in obstetric complications.

The results of this review highlight the importance of investigating which method is most suitable for uncovering the effect of a multisensory birthing room versus a standard birthing room. The existing studies show that the current approaches are not always comprehensive.

The fact that the rooms are arranged very differently means comparing the effect on its users is extremely difficult. A clear definition of multisensory birthing room and detailed descriptions of how the birthing rooms were designed and furnished is needed in future studies.

Implications for Practice

When designing future delivery rooms, nature should be taken into consideration, as it has a documented positive effect on the birth experience. In the same way, there is a tendency to reduce birth complications in birth rooms that incorporate nature.

Further research is required in order to achieve a higher level of insight in the field

There was not an agreed definition of a multisensory birth room. It would be preferable to have a consensus on the definition of a multisensory birth room, with the aim of gathering knowledge that can direct the future design of birth room.

Footnotes

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was declared.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was supported by Marie Pedersen and Jensine Heibergs foundation and the North Regional Health Science Research Foundation.

ORCID iDs

Anya Eidhammer, MD

Dorte Melgaard, PhD

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